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Why the Wait for Hepatitis C Treatment? A Doctor Explains

August 28, 2015

With the arrival of new, more effective hepatitis C drugs, there may be some confusion as doctors and patients wade through the new guidelines and access issues. To help answer some of the most pressing hepatitis C treatment questions, spoke to Maribel Rodriguez-Torres, M.D., a leader in hepatitis C research and treatment in Puerto Rico.

Why is it that my doctor told me I have to wait until my disease gets worse before I can go on treatment for hepatitis C (HCV)?

Maribel Rodriguez-Torres, M.D.

Maribel Rodriguez-Torres, M.D.

This is an important concept for patients to understand. Healthy patients with a recent HCV positive diagnosis may not qualify for treatment, even though treatment could cure their HCV. Instead, the drugs are preserved for patients who are the most sick. Payers are looking for different ways to restrict coverage of HCV direct acting antivirals.

Although this might sound unfair, you have to see both sides of the equation. The drugs that can cure HCV are extremely expensive. Looking from the point of view of an insurer, it is economically impossible to pay for the medication that would be needed to treat all the infected patients at this moment. The number of patients is too great; in addition, it is likely that the number of infections is being underreported. Every physician in the HCV community knows that there are many, many infected patients who have never been diagnosed.

As a global community, we have to recognize that we cannot treat all infected patients today. We have to treat as many patients as we can, and that usually means treating the sickest patients first. I do not believe that we will be able to eradicate the disease by 2030, as some experts have said. There is not enough money in the health care system and there are too many undiagnosed patients. To me, it is clear that we need to prioritize patients.

Prioritization is usually determined based on a patient's level of cirrhosis, or liver scarring. There is a huge benefit to treating a patient who is very sick before treating a patient who is generally healthy. The first and most important benefit is that you save that patient's life. The second benefit is that you eliminate the massive health care cost of taking care of a dying person. Patients with decompensated cirrhosis (extremely damaged liver that might need transplantation) cost the health care system approximately USD $50,000 per year. HCV patients who are not cirrhotic cost less than USD $5,000 per year in health care dollars.

In addition, some people with early stage disease can live their whole lives and never see a worse progression. That happens in about 15% of patients. I don't have any concerns with the practice of treating the sickest patients because they are the most urgent cases, and others can wait.

Maribel Rodriguez-Torres is the founder and president of Fundación de Investigación (FDI), the largest clinical research center in Latin America. She received both her M.D. and her postgraduate fellowship at the School of Medicine of the University of Puerto Rico. She dedicates much of her time today to working with the government to increase access to treatment for patients without health insurance.

Copyright © 2015 Remedy Health Media, LLC. All rights reserved.

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